| NPI | 1174183230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A200430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351045679) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-02-14 |